title: What is so tough about self-monitoring of blood glucose? Perceived obstacles among patients with Type 2 diabetes.
abstract: OBJECTIVE
  To identify patient-reported obstacles to self-monitoring of blood glucose among those with Type 2, both insulin users and non-insulin users, and to investigate how obstacles are associated with frequency of self-monitoring and use of self-monitoring data.
  
  
  METHODS
  Patients with Type 2 diabetes (n = 886, 65% insulin users) who attended a 1-day diabetes education conference in cities across the USA completed a survey on current and recommended self-monitoring of blood glucose frequency, how they used self-monitoring results and perceived obstacles to self-monitoring use. Exploratory factor analysis examined 12 obstacle items to identify underlying factors. Regression analyses examined associations between self-monitoring of blood glucose use and the key obstacle factors identified in the exploratory factor analysis.
  
  
  RESULTS
  Three obstacle factors emerged: Avoidance, Pointlessness and Burden. Avoidance was the only significant independent predictor of self-monitoring frequency (β = -0.23, P < 0.001). Avoidance (β = -0.12, P < 0.01) and Pointlessness (β = -0.15, P < 0.001) independently predicted how often self-monitoring data were shared with healthcare professionals and whether or not data were used to make management adjustments (Avoidance: odds ratio = 0.74, P < 0.001; Pointlessness: odds ratio = 0.75, P < 0.01). Burden was not associated with any of the self-monitoring behavioural measures. Few differences between insulin users and non-insulin users were noted.
  
  
  CONCLUSIONS
  Obstacles to self-monitoring of blood glucose use, both practical and emotional, were common. Higher levels of Avoidance and Pointlessness, but not Burden, were associated with less frequent self-monitoring use. Addressing patients' self-monitoring-related emotional concerns (Avoidance and Pointlessness) may be more beneficial in enhancing interest and engagement with self-monitoring of blood glucose than focusing on day-to-day, behavioural issues (Burden).
authors.affiliation: Department of Psychiatry, University of California, San Diego, CA, USA; Behavioral Diabetes Institute, San Diego, CA, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: Polonsky
authors.forename: L
authors.initials: L
authors.lastname: Fisher
authors.forename: D
authors.initials: D
authors.lastname: Hessler
authors.forename: S V
authors.initials: SV
authors.lastname: Edelman
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000523:psychology* / Q000706:statistics & numerical data; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012648:Self Care / Q000523:psychology*; D012938:Social Perception; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin